The American Society of Addiction Medicine defines addiction as a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Addictions nursing encompasses a broad spectrum of nursing practices. It involves primary, secondary, and tertiary levels of care. Addiction nurses practice at all levels of nursing including Licensed Practical Nurses (LPNs), Registered Nurses (RNs), and Advanced Practice Nurses (APNs). The field of addictions nursing practice includes mental health, physical health and wellness, and behavioral health nursing treatments and interventions.
- The term addiction includes problems related to substance use (including alcohol, nicotine, and other drugs) and behavioral addictions such as gambling, as well as the impact on the lives of the individuals and their significant others, their families and the community as a whole.
- Addiction nursing may include nursing assessment (RN) of individuals at risk or diagnosed with substance use disorders and gambling addiction. The assessments may include mental health status, medical status, motivation for change, socio/economic status, and barriers to treatment.
- Advances Practice Nurses, such as a Nurse Practitioners, in addiction treatment may be tasked to identify and diagnose substance use, medical, and mental health conditions, as well as planning and prescribing treatments, including Medically Assisted Treatment (MAT).
- Addictions nurses collaborate with multiple disciplines in treatment planning and interventions for the clientele under their care. Treatment planning and interdisciplinary collaboration are essential components of substance use disorder and gambling addiction intended to achieve the best outcomes and assist clients to accomplish their goals.
- Addiction nurses utilize a multitude of skills and interventions in caring for persons with substance use disorder and gambling addictions including, but not limited to: administering medications as ordered, health teaching/coaching, wellness, group therapies, behavioral therapies, holistic modalities, and modeling social and medical norms.
- Addiction nurses must practice self-care and have self-awareness in dealing with this vulnerable population, both for the mental and psychological wellbeing of the nurse, and for the optimal care of the client.
Nurse Advisory Panel
The first OASAS Nurse Advisory panel (NAP), named in 2009, is comprised of a group of addictions nursing content experts, experienced clinicians, researchers and managers convened to advise the Commissioner on OASAS initiatives in New York state. Topics of special focus can include, but are not limited to:
- Education and training opportunities for nurses;
- Evidence-based practices in addictions treatment;
- The integration of basic and specialty components of addiction treatment;
- Public relations activities related to nursing roles at OASAS and the scope of the nursing practice as related to addictions nursing;
- Providing leadership for change in practices and policies and providing support for legislation to advance quality care related to the prevention, treatment and recovery of New York state citizens.
Licensed Practical Nurses
Licensed Practical Nurses in OASAS programs are not “medical staff,” but fall under the larger heading of “clinical staff”. See Part 800.3 (a) In OASAS programs a Licensed Practical Nurses may provide the following nursing care under the direction of another licensed practitioner1:
- Administer most medications and immunizations
- Observe, measure, record, report data relating to patient mental and physical status
- Conduct required clinical or nursing treatments
- Supervise unlicensed clinical staff
- Record and report patient goals for consideration in a treatment/recovery plan
- Interview patients and record data for admission or discharge
- Conduct orientation sessions for patients and families
Licensed Practical Nurses may not provide a “nursing diagnosis"2; triage or assess patient needs; interpret clinical data to make a conclusion about level of care or treatment plans; act independently based on data; create, initiate or alter treatment goals; establish treatment/recovery plans; provide care they are not competent to provide.
Frequently Asked Questions
Q: What is an “appropriate degree of supervision” for an LPN?
A: The NYS Education Department provides the following guidance:
"The supervising practitioner must consider specific circumstances such as patient needs, LPN skill and abilities, other staffing."
Q: What does it mean for an LPN to be “under the direction of another licensed practitioner”?
A: State Education provides the following guidance:
For a licensed LPN, “under the direction of” means that the supervising practitioner must be:
- Present on the premises OR
- Within a reasonable distance (15 minutes away) and immediately available by telephone
Q: Are there consequences for delegating RN duties to LPNs in OASAS programs?
A: Both the delegating RN and the LPN could be subject to a potential charge of unprofessional conduct: RN for inappropriate delegation of professional responsibilities (Regent Rules 29.1(b)(1)); LPN for acting outside the scope of nursing (Regent Rules 29.1(b)(9)). Further, inappropriate use of LPNs may expose programs and other staff to potential litigation and administrative action.
Registered Nurse Training
Medication Self-Administration with Staff Oversight
A two-part required training for all Registered Nurses (RNs) who will be teaching authorized staff in OASAS-certified programs to oversee the self-administration of medication.
- Part I. Complete an online, self-paced course. In order to receive credit and become eligible for part II of the training, participants must complete a brief exam and receive a certificate of completion after watching the training video.
- Part II. Once you've received a certificate of completion, contact Helio Health to register for Registered Nurse Part II Training: Medication Self-Administration with Staff Oversight, an in-person classroom training.
There are several professional organizations related to nursing at an international, national, and state level. These organizations provide professional support, education, and assistance relevant to nurses and nursing.